Healthcare Provider Details

I. General information

NPI: 1235449042
Provider Name (Legal Business Name): DAVID BRUCE SANDBERG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 26TH ST E
WILLISTON ND
58801-3046
US

IV. Provider business mailing address

917 16TH AVE SE
MINOT ND
58701-6778
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-9168
  • Fax:
Mailing address:
  • Phone: 701-833-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3298
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: